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Case 155139

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

PERAPICAL LESION ON VITAL 13, HISTORY OF EWING SARCOMA ON LEFT ZYGOMA

Referral reason

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1 Files Info

Canaray 155139

1. Osseous dysplasia with simple bone cyst formation in anterior right maxilla

There is a delicately corticated, oval shaped radiolucency located immediately palatal to teeth 12, 13, and 14. This radiolucency is surrounded by an ill-defined margin of sclerotic-appearing granular bone. Although this entity scallops along the palatal root surfaces of teeth 14, 13, and 12, there is no evidence of displacement or root resorption, and their lamina durae remains partially intact. The palatal surface of the alveolar process in this region appears slightly expanded, and its cortex appears thinned, but intact. Overall, these findings are suggestive of an osseous dysplasia with the concomitant presence of a simple bone cyst. However, because simple bone cysts are not usually observed in the maxilla, an incisional biopsy is recommended to substantiate this interpretation.

Additional orthogonal views of 13

These additional orthogonal cross-sectional images demonstrate that the radiolucency in the anterior right maxilla is located palatal in the apical half of the root of tooth 13. The apical periodontal ligament space of this tooth appears thin and uniform, and the lamina dura intact. No signs of root resorption are present. These findings suggest that the radiolucency did not arise secondary to inflammatory disease in tooth 13, which is consistent with the reportedly normal vitality test result.

Additional orthogonal views of tooth 14

These additional orthogonal cross-sectional images demonstrate that the radiolucency in the anterior right maxilla abuts the mesiopalatal surface of the apical third of the palatal root of tooth 14. However, its lamina dura appears partially intact, and there are no signs of root resorption. These findings suggest that the radiolucency likely did not arise secondary to inflammatory disease arising from tooth 14, but clinical vitality testing is necessary to substantiate this interpretation.

Additional orthogonal views of 12

These additional orthogonal cross-sectional images demonstrate that the radiolucency in the anterior right maxilla abuts the distopalatal surface of the root apex of tooth 12. There is no evidence of displacement or root resorption. These findings suggest that the radiolucency did not arise secondary to inflammatory disease arising from tooth 12, but clinical vitality testing is necessary to substantiate this interpretation.

Additional orthogonal views of tooth 13

These additional orthogonal cross-sectional images demonstrate that the radiolucency in the anterior right maxilla is located palatal to the apical half of the root of tooth 13. The apical periodontal ligament space of this tooth appears thin and uniform, and the lamina dura intact. No signs of root resorption are present. These findings suggest that the radiolucency did not arise secondary to inflammatory disease in tooth 13, which is consistent with the reportedly normal vitality test result.

2. History of left maxillary surgery

A fixation plate and four fixation screws are observed along the anterior wall and the zygomatic process of the left maxilla, as well as the partially captured left zygomatic bone. The posterolateral wall of the left maxillary sinus appears partially dehiscent. These findings are consistent with the reported history of sarcoma removal in this region. Based on what can be visualized, there are no radiographic signs of recurrence.

Impacted tooth 28

Tooth 28 is mesioangularly impacted. The crown of this tooth is located immediately distal to the distobuccal and palatal roots of tooth 27, and has caused external resorption in this region. The root apices of this tooth are located adjacent to the posterior maxillary wall. The periodontal ligament space is not completely visualized around the root circumference of this impacted tooth, which suggests the possibility of ankylosis. The residual follicle surrounding the crown of this impacted tooth appears hypoplastic.

3. External resorption on tooth 27DB+P

External resorption is observed in the distobuccal and palatal roots of tooth 27 due to its close proximity to the impacted tooth 28. The apical half of the distobuccal root of tooth 27 has been resorbed, and mild external resorption is evident along the furcal surface of its palatal root. There is no evidence of endodontic pathology in this tooth, despite this finding.

4. Mild mucositis of both maxillary sinuses

Mild mucositis is present in both maxillary sinuses. This represents an incidental finding with no clinical significance.

5. Palatal torus

A palatal torus is present in the midline of the hard palate. This is an incidental finding with no clinical significance.

6. Palatine tonsilloliths

Tonsilloliths are present in the palatine tonsils. This is an incidental finding with no clinical significance due to the spontaneous exfoliation of tonsilloliths.